Congress Probing VA Bonuses to Doctors

by David Pittman David Pittman Washington Correspondent, MedPage Today
August 29, 2013

WASHINGTON -- A congressional committee is using a recent report questioning performance bonuses given to Department of Veterans Affairs physicians as reason to examine a range of pay-for-performance issues at the VA.

Furthermore, medical centers and networks don't "have reasonable assurance that the goals make a clear link between performance pay and providers' performance," the report stated.

In response to that report and other performance-pay issues, the House Veterans' Affairs Committee will hold a hearing Sept. 9 at the Allegheny County Courthouse in Pittsburgh examining bonuses VA administrators received even as apparently preventable deaths and patient-safety problems were occurring at their facilities.

"This is irrefutable proof of what we've known for quite some time: that in many cases, VA's performance pay and bonus system has absolutely nothing to do with performance," House Veterans' Affairs Committee Chair Jeff Miller (R-Fla.) said in a statement to MedPage Today. "In light of these disturbing findings, Secretary [Eric] Shinseki owes it to America's veterans and American taxpayers to conduct a top-to-bottom review of VA's performance appraisal system, just as we've been calling on him to do for months."

Most VA providers are eligible for up to $15,000, or 7.5% of their pay, whichever is less, in annual bonuses for hitting certain performance goals and objectives. The VA's 152 medical centers and 21 networks help set the goals providers must hit to receive the bonuses.

In fiscal 2011, the VA paid roughly 80% of its nearly 22,500 providers nearly $150 million in performance pay, at an average of $8,049 per provider who received the pay. The agency also gave more than $10 million in performance awards to more than 4,000 providers, at an average of $2,587 per provider.

The GAO examined the Veterans Health Administration (VHA) performance pay and award system by visiting VA medical centers in Atlanta, Dallas, Seattle, and Togus, Maine to review documentation for the system.

"At these medical centers, all providers GAO reviewed who were eligible for performance pay received it, including all five providers who had an action taken against them related to clinical performance in the same year the pay was given," the GAO report said.

Issues included failing to read mammograms and other complex images competently, practicing without a current license, and leaving residents unsupervised during surgery.

The VA's policy is unclear about certain items, such as what to document regarding whether a performance-related action should result in a reduction in performance pay.

The VA told MedPage Today that it agrees with the GAO's findings and is working to increase oversight of the program.

"The VA has already taken steps to strengthen the process and increase monitoring requirements so that pay and awards are supported by proper documentation of performance and meet established standards," a spokesperson for the department said in an email.

The House Veterans Affairs Committee will probe this issue and others like it at the hearing in Pittsburgh, which comes on the first day after Congress reconvenes after its long August break. Specifically, the hearing will look at recent events in Atlanta, Pittsburgh, Dallas, Buffalo, N.Y., and Jackson, Miss.

"The purpose of this hearing is to examine whether VA has the proper management and accountability structures in place to stop the emerging pattern of preventable veteran deaths and serious patient-safety issues at VA medical centers across the country," the committee said in a release.

In Pittsburgh, more than 20 patients contracted Legionnaires' disease between January 2011 and November 2012. Five died.

The hospital failed to control for conditions to prevent Legionnaires, according to the VA Inspector General. Meanwhile, the medical center director received a bonus of $12,924 in 2011.

At the VA hospital in Buffalo, 18 veterans contracted hepatitis when workers reused insulin cartridges designed for single use.

In Atlanta, the former medical center director there collected more than $65,000 in bonuses from 2008 to 2011 as wait times for mental health treatments grew and three mental health patients died, according to news reports.

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